Objective To obtain the most effective diagnosis method for diabetic muscle infarction by using the evidence based medicine.Methods In March 2006 we attempted to find the guideline,systematic review,random controlled trials,clinical controlled trials and case reports for the diagnosis of diabetic muscle infarction by searching Cochrane Library(Issue 4,2005),Embase(1974—2005),Medline(1966—2005)and CNKI database(1949—2005),then critically appraised the quality of available evidences.Results According to the present evidence,when the the patient was suspected to have diabetic muscle infarction,we should choose the sonography to exclude some common diseases at first;the CT examination of all the patients showed no obvious manifestations;the normal MRI examination of 67 patients showed obvious manifestations;the patients who did the muscle biopsy or needle biopsy did not develop any complications.Conclusion The diagnosis of diabetic muscle infarction should be based on the clinical presentations and MRI outcome,but when the diagnosis is uncertain,we should use the needle biopsy to confirm the diagnosis at an early time.

Acupuncture Points ; Acupuncture Therapy ; methods ; Combined Modality Therapy ; Coronary Artery Disease ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; Myocardial Ischemia ; therapy

Child, Preschool ; Cysts ; Diagnostic Errors ; Humans ; Leiomyoma ; diagnosis ; Male ; Nose Neoplasms ; diagnosis ; Vestibular Diseases

OBJECTIVETo examine the efficacy and safety of dual blockade of the renin-angiotensin-aldosterone system (RAAS) among patients with type 2 diabetic kidney disease.

DATA SOURCESWe searched the major literature repositories, including the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE, for randomized clinical trials published between January 1990 and October 2015 that compared the efficacy and safety of the use of dual blockade of the RAAS versus the use of monotherapy, without applying any language restrictions. Keywords for the searches included "diabetic nephropathy," "chronic kidney disease," "chronic renal insufficiency," "diabetes mellitus," "dual therapy," "combined therapy," "dual blockade," "renin-angiotensin system," "angiotensin-converting enzyme inhibitor," "angiotensin-receptor blocker," "aldosterone blockade," "selective aldosterone blockade," "renin inhibitor," "direct renin inhibitor," "mineralocorticoid receptor blocker," etc.

STUDY SELECTIONThe selected articles were carefully reviewed. We excluded randomized clinical trials in which the kidney damage of patients was related to diseases other than diabetes mellitus.

RESULTSCombination treatment with an angiotensin-converting enzyme inhibitor supplemented by an angiotensin II receptor blocking agent is expected to provide a more complete blockade of the RAAS and a better control of hypertension. However, existing literature has presented mixed results, in particular, related to patient safety. In view of this, we conducted a comprehensive literature review in order to explain the rationale for dual blockade of the RAAS, and to discuss the pros and cons.

CONCLUSIONSDespite the negative results of some recent large-scale studies, it may be immature to declare that the dual blockade is a failure because of the complex nature of the RAAS surrounding its diversified functions and utility. Further trials are warranted to study the combination therapy as an evidence-based practice.

Angiotensin Receptor Antagonists ; therapeutic use ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Animals ; Antihypertensive Agents ; therapeutic use ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Nephropathies ; drug therapy ; Humans ; Renin-Angiotensin System ; drug effects

The effects of continuous subcutaneous insulin injection (CSII, n=306) and multiple subcutaneous insulin injection (MSII, n=310)on hyperglycemia in patients with diabetes mellitus were compared. The results suggest that the effect of CSII is more prompt and efficient with lower incidence of hypoglycemia as compared with MSII.

Objective To explore the relationship between genetic variation in PAF-AH V279F and coronary heart disease among Han population in Beijing.Methods A case-control study was held which enrolled 124 patients with coronary heart disease and 103 normal subjects.The genotype of PAF-AH V279F was determined with allele-specific polymerase chain reaction(AS-PCR)method. Results The highest frequency of PAF-AH V279F genetic variation was VV genotype(92.2%),the next was VF genotype(5.8%)and the lowest was FF genotype(2.0%)among the studied Han population in Beijing.In the coronary heart disease group the frequency of 279 V→F carriers was significantly higher than in the control group(19.3% vs.7.8%,P＜0.05)and F allele frequency was also higher(12.1% vs.4.9%,P＜0.01).Among the coronary heart disease group,the V279F variation frequency and the F allele frequency were significantly higher in patients with myocardial infarction than in those without myocardial infarction(27.3% vs.13.0%,17.3% vs.8.0%,both P＜0.05).In multiple logistic regression analysis,the odds ratio(OR)of V279F genetic variation for coronary heart disease was 1.919(95% CI:1.448-2.544,P=0.033).Conclusions The PAF-AH V279F genetic variation may be a novel genetic marker for high risk of coronary heart disease.

Objective To explore the changes of tumor necrosis factor-?(TNF-?) in serum and cerebrospinal fluid(CSF) of children with acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia(AML) and its clinical significance.Methods TNF-? in serum and CSF were measured by radioimmunoassay and CSF samples were obtained from 31 cases of childhood acute leukemia before treatment, on complete remission(CR), and continuous CR.Results Serum TNF-? was in ALL and AML before treatment [(24.35?4.84) pmol/L and(28.65?5.12) pmol/ L],which were significantly higher than those of healthy controls[(11.2 8? 1.69) pmol/L, P

OBJECTIVETo observe the effects of matrine on renal tubulointerstitial fibrosis in unilateral ureteral obstruction (UUO) rat model and to explore its mechanisms.

METHODSModel rats of UUO were established and randomly divided into 6 groups: the normal group, the sham group, the UUO model group, the fusinopril treated group (F group), the high dose and low dose matrine treated groups (HM and LM). The expressions of matrix metalloproteinase-3 ( MMP-3), tissue inhibitor of metalloproteinase-1 (TIMP-1), fibronectin (FN), connective tissue growth factor (CTGF) and alpha-smooth muscle actin (alpha-SMA) were determined semi-quantitatively by immunohistochemistry on the 14th day.

RESULTSThe expression of MMP-3 in the UUO model rats was significantly lowed on the 14th day, compared with that in rats not modeled in the normal and the sham groups (P < 0.05), but it was higher in the three treated groups than that in the UUO model group (P < 0.05); the expressions of TIMP-1, FN, CTGF and alpha-SMA were lower in the normal group and sham UUO group than those in all the UUO model groups, while they were lower obviously in the three treated groups than those in the UUO model group (P < 0.05); there was no significant difference in the above-mentioned indexes between HM group and F group (P < 0.05).

CONCLUSIONMatrine could decrease the expressions of TIMP-1, FN, CTGF and alpha-SMA in the tubulointerstitium, and partly restore the expression of MMP-3, so as to delay the progression of renal tubulointerstitial fibrosis.

Alkaloids ; pharmacology ; therapeutic use ; Animals ; Fibronectins ; biosynthesis ; genetics ; Fibrosis ; drug therapy ; etiology ; Kidney Tubules ; pathology ; Male ; Matrix Metalloproteinase 3 ; biosynthesis ; genetics ; Phytotherapy ; Quinolizines ; pharmacology ; therapeutic use ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Tissue Inhibitor of Metalloproteinase-1 ; biosynthesis ; genetics ; Ureteral Obstruction ; complications

Background and purpose: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new minimally invasive method in the dignosis for mediastinal lymph nodes. This study was to evaluate the diagnostic yield of EBUS-TBNA for mediastinal lymph nodes. Methods: Twenty patients with mediastinal lymph nodes found by CT underwent the dignosis by EBUS-TBNA form April 1st 2009 to July 16th 2009. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were evaluated. Results: Twenty patients with 37 lymph node groups were studied. Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EBUS-TBNA for diagnostic were 84.62%, 100%, 100%, 77.78% and 90.00%, respectively. The diagnostic accuracy for cancer was 100%. The operation time was 11.9min per group in average with no serious complication. The median length of hospital stay was 1 (range from 1 to 17 days) day after operation. There were significant differences in the average operation time between the first three patients and the others (36.25 min vs. 7.76 min; z=3.247, P=0.001). Conclusion: Endobronchial ultrasound-guided transbronchial needle aspiration proved to be a safe procedure with a high yield for the diagnosis of mediastinal lymph nodes.

Objective To explore a new model of medical humanity education in new situation. Methods Extensive survey was carried out among medical students,and discussion and consultation were hold to faculty and education administers.A new teaching model was established. Results A curriculum system with 1 or 2 core courses supported by some elective courses and social practice is under the process of implementation and achieved preliminary success.Conclusion The medical humanity education should pay attention to the development of connotation instead of pursuing the extension of quantity blindly,which means that students' school work must be eased by focusing on self-study and self-education.Medical students'life path with high-minded personality training should be strengthened.